Diurnal variation in tooth movement in response to orthodontic force in rats

Effect of applying intermittent force with and without vibration on orthodontic tooth movement

PURPOSE

This study aimed to determine whether orthodontic tooth movement could be accelerated by applying an intermittent force protocol. It also examined the effect of applying additional vibrational forces on orthodontic tooth movement and root resorption rates.

METHODS

This study included 24 patients (16 males and 8 females) who underwent orthodontic treatment involving first premolar extraction and distal movement of the canines in the maxilla. A Hycon device (Adenta GmbH, Gilching, Germany) was used for canine distalization in all patients. The patients were randomly divided into two groups: one group received 20 min of vibration per day using the AcceleDent device (OrthoAccel Technologies, Inc., Bellaire, TX, USA), while the other group received no vibration. In addition, a split-mouth design was used: an activation-only force protocol was applied on one side, and an intermittent activation-deactivation-activation (ADA) protocol was applied on the other. The duration required for complete canine tooth distalization on each side was calculated. In addition, the effect of vibration on the orthodontically induced root resorption was examined.

RESULTS

The intermittent ADA protocol significantly accelerated orthodontic tooth movement compared to the activation-only protocol (p < 0.05). The application of additional vibration did not affect the orthodontic tooth movement rate (p > 0.05).

CONCLUSIONS

Using a Hycon device and following an ADA protocol provided significantly faster canine distalization than the activation-only protocol (p < 0.05). This intermittent force method proved very effective in closing the spaces. However, vibration did not significantly affect the orthodontic tooth movement rate (p > 0.05).

Chronotherapy in dentistry: A scoping review

The circadian clock modulates almost all vital aspects of our physiology and metabolism, including processes relevant to dentistry, such as healing, inflammation and nociception. Chronotherapy is an emerging field aiming to improve therapeutic efficacy and decrease adverse effects on health outcomes. This scoping review aimed to systematically map the evidence underpinning chronotherapy in dentistry and to identify gaps in knowledge. We conducted a systematic scoping search using four databases (Medline, Scopus, CINAHL and Embase). We identified 3908 target articles screened by two blinded reviewers, and only original animal and human studies investigating the chronotherapeutic use of drugs or interventions in dentistry were included. Of the 24 studies included, 19 were human studies and five were animal studies. Chrono-radiotherapy and chrono-chemotherapy reduced treatment side effects and improved therapeutic response, leading to higher survival rates in cancer patients. Animal studies reported that tooth movement and periodontal tissue response to orthodontic forces follow a diurnal rhythm that might influence bone metabolism. Profound and prolonged local anesthesia could be achieved when injected in the evening. Although the overall quality of the included studies was low, chronotherapy applications in dentistry seem to have favourable outcomes, especially in head and neck cancer treatments.

A randomized trial on the effects of root resorption after orthodontic treatment using pulsating force

Background

An orthodontic device that moves teeth with pulsating force was invented and underwent a single center, controlled, clinical trial to test its safety and efficacy for treatment. The device has a custom-made thermo-plastic mouthpiece which fits over the teeth with an inflatable silicone element. A console that measures and controls the pulsating force level in real-time controls the air pressure that delivers a pulsating force. In this study, the effect of the device on root resorption during orthodontic treatment was evaluated using 3D cone beam computed tomography and compared with a control group of patients who received Invisalign treatment.

Methods

Twenty-eight subjects were enrolled in the investigational arm and 15 in the control group. Subjects were followed until the average score of the mandibular and maxillary teeth achieved a Little’s Irregularity Index of 1.5 mm or less.

Results

There were no adverse events reported throughout the study for either treatment arm. No clinically significant root resorption was observed for either group. The investigational device did not cause root resorption greater than the control group. Both devices produced a safety profile compared to current orthodontic techniques.

Conclusion

The investigational device did not produce more root resorption than similar conventional orthodontic appliances.

Trial registration

ClinicalTrials.gov, NCT03421886. Registered 12 January 2018 - Retrospectively registered.

Circadian rhythm of osteocalcin in the maxillomandibular complex

The human body displays central circadian rhythms of activity. Recent findings suggest that peripheral tissues, such as bone, possess their own circadian clocks. Studies have shown that osteocalcin protein levels oscillate over a 24-hour period, yet the specific skeletal sites involved and its transcriptional profile remain unknown. The current study aimed to test the hypothesis that peripheral circadian mechanisms regulate transcription driven by the osteocalcin promoter. Transgenic mice harboring the human osteocalcin promoter linked to a luciferase reporter gene were used. Mice of both genders and various ages were analyzed non-invasively at sequential times throughout 24-hour periods. Statistical analyses of luminescent signal intensity of osteogenic activity from multiple skeletal sites indicated a periodicity of ~ 24 hrs. The maxillomandibular complex displayed the most robust oscillatory pattern. These findings have implications for dental treatments in orthodontics and maxillofacial surgery, as well as for the mechanisms underlying bone remodeling in the maxillomandibular complex.

Expression of genes for gelatinases and tissue inhibitors of metalloproteinases in periodontal tissues during orthodontic tooth movement

Orthodontic tooth movement progresses by a combination of periodontal ligament (PDL) tissue and alveolar bone remodeling processes. Besides the remodeling of alveolar bone around the moving teeth, the major extracellular matrix (ECM) components of PDLs, collagens, are degenerated, degraded, and restructured. Matrix metalloproteinases (MMPs) and their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), act in a co-ordinated fashion to regulate the remodeling of periodontal tissues. We hypothesized that the expression levels of the genes for MMP-2, MMP-9, and TIMPs 1-3 are increased transiently in the periodontal tissue during orthodontic tooth movement. To test this hypothesis, we employed an animal model of tooth movement using rats, as well as in situ hybridization to analyze the expression levels of Mmp-2, Mmp-9, and Timps 1-3. The expression levels of these genes increased transiently in cells of periodontal tissues, which include cementoblasts, fibroblasts, osteoblasts, and osteoclasts, at the compression side of the moving teeth. The transient increases in gene expression at the tension side were mainly limited to osteoblasts and cementoblasts. In conclusion, the expression levels of Mmp-2, Mmp-9, and Timps 1-3 increase transiently during orthodontic tooth movement at both the tension and compression sides. The expression of these genes is regulated differentially in the periodontal tissue of the tension side and compression side. This altered pattern of gene expression may determine the rate and extent of remodeling of the collagenous ECM in periodontal tissues during orthodontic tooth movement.

Effects of continuous and interrupted orthodontic force on interleukin-1beta and prostaglandin E2 production in gingival crevicular fluid

The purpose of this study was to evaluate the effects of a light continuous force and an interrupted force with weekly reactivation on interleukin-1beta (IL-1beta) and prostaglandin E(2) (PGE(2)); possible interactions between these 2 potent mediators of the bone resorption process were assessed in vivo. Ten healthy young adults (mean age 20.6 years, 2 men, 8 women) with 4 premolars extracted were assessed. In each subject, 1 maxillary canine (E1) received continuous force with a nickel-titanium coil spring. The opposite canine (E2) received an interrupted force with a screw-attached retractor; the force was reactivated weekly by 2 turns of the screw. An antagonistic canine was used as a control. Gingival crevicular fluid was collected from the distal side of each tooth, 10 times in 3 weeks, and IL-1beta and PGE(2) levels were measured. For E1, the IL-1beta level showed a significant elevation at 24 hours and then decreased and maintained an insignificant but high mean concentration, compared with the control site. The PGE(2) level showed a significant elevation at 24 hours and then decreased. For E2, a significant elevation of IL-1beta level was observed at 24 hours and a greater significant elevation at 24 hours after the first reactivation, compared with the control sites. The PGE(2) level increased significantly at 24 hours and remained high for 1 week. The synergistic up-regulation of PGE(2) by appliance reactivation and secreted IL-1beta was not evident with either type of force after 1 week. Both experimental sites showed significant tooth movement compared with the control sites at 3 weeks; however, there was no significant difference between the 2 experimental sites. A well-controlled mechanical stress with timely reactivation can effectively upregulate IL-1beta secretion, but there might be limitations in increasing the mediator levels, because of the feedback mechanisms in vivo. In addition, the analysis of crevicular fluid is a useful method for assessing cellular response to orthodontic force in vivo.

Expression of MMP-8 and MMP-13 genes in the periodontal ligament during tooth movement in rats

Periodontal ligament tissue is remodeled on both the tension and compression sides of moving teeth during orthodontic tooth movement. The present study was designed to clarify the hypothesis that the expression of MMP-8 and MMP-13 mRNA is promoted during the remodeling of periodontal ligament tissue in orthodontic tooth movement. We used the in situ hybridization method and semi-quantitative reverse-transcription/polymerase chain-reaction analysis to elucidate the gene expression of MMP-8 and MMP-13 mRNA. Expression of MMP-8 and MMP-13 mRNA transiently increased on both the compression and tension sides during active tooth movement in vivo. The gene expression of MMP-8 and MMP-13 was induced by tension, while compression indirectly promoted the gene expression of MMP-8 and MMP-13 through soluble factors in vitro. Thus, we concluded that the expression of MMP-8 and MMP-13 is differentially regulated by tension and compression, and plays an important role in the remodeling of the periodontal ligament.

Inactivated periods of constant orthodontic forces related to desirable tooth movement in rats

AIM

To examine the effects of inactive periods of force on the amount of tooth displacement and root resorption during experimental tooth movement in rats.

SAMPLE

Sixty 11-week-old male Sprague-Dawley rats.

METHOD

The maxillary first molar (M1) was moved mesially using a removable titanium-nickel alloy closed coil spring for 14 days. The rats were divided into four groups with, 0, 1, 4, and 9 hours of inactivation per day.

RESULTS

Tooth displacement in the 0- and 1-hour groups was significantly greater than that in the 9-hour group. The area of root resorption in the 4- and 9-hour groups was significantly less than that in the 0- and 1-hour groups. There was no significant difference in root resorption between 0- and 1-hour groups, and also between 4- and 9-hour groups.

CONCLUSION

The distance of tooth displacement gradually decreased as the inactive period increased, whereas root resorption suddenly decreased between 1 and 4 hours of inactive orthodontic force.

Diurnal variation in the response of the mandible to orthopedic force

Bone and cartilage metabolism is known to be more active during rest than during periods of activity. The purpose of this study was to examine the hypothesis that mandibular retractive force could be more effective when applied to rats during rest. Mandibular retractive force caused a considerable reduction in the condylar length in experimental groups, and the magnitude of this reduction was greater in the Light-period (08:00-20:00) group than in the Dark-period (20:00-08:00) group. The differentiation and proliferation of chondrocytes were inhibited in animals in the Light-period group, compared with those in the Dark-period group. These results suggest that the orthopedic effects of mandibular retractive force vary depending on the time of day the force is applied, and that such force may be more effective while animals are resting than while they are active.

Circadian and longitudinal variation of serum C-telopeptide, osteocalcin, and skeletal alkaline phosphatase in C3H/HeJ mice

Inbred strains of mice are increasingly being used as an animal model to investigate skeletal disorders relevant to humans. In the bone field, one of the most convenient endpoints for evaluating genetic, physiological, or pharmaceutical perturbations is the use of biochemical markers. To apply biochemical markers in an effective manner, it is of key importance to establish the biological variation and appropriate sampling time. In this study, we evaluate two components: (i) circadian changes, and (ii) longitudinal variation for three serum markers, osteocalcin, C-telopeptide, and skeletal alkaline phosphatase (sALP), using 6-week-old C3H/HeJ (C3H) mice. To study circadian rhythms, the mice were randomly divided into eight groups of 15 mice each. Blood was collected at 3 h intervals, starting at 9:00 A.M. and continuing until 6:00 A.M. the next day. To determine whether circadian rhythm is intrinsically regulated or influenced by restricted food intake, it was also studied after a 12 h fasting period. Serum osteocalcin and C-telopeptide levels were measured by enzyme-linked immunoassay (ELISA) and skeletal alkaline phosphatase by a kinetic assay. The results demonstrated significant circadian variations in osteocalcin and C-telopeptide levels with a peak value between 0900 and 1200 h during daytime and a nadir between 15:00 and 18:00 h. The peak levels of C-telopeptide and osteocalcin were 26%-66% higher as compared with 24 h mean values. The pattern of the circadian variation of C-telopeptide and osteocalcin was similar in female and male animals and was not significantly affected by restricted food intake. The sALP levels were only marginally affected by the circadian rhythm. Longitudinal variations, expressed as coefficient of variation (CV), for osteocalcin, C-telopeptide, and sALP concentrations were 17%, 14%, and 16%, respectively. In addition, the longitudinal variations were not significantly influenced by the time of blood collection in sALP and osteocalcin levels, whereas C-telopeptide levels showed significantly higher within-subject day-to-day variation in morning samples, as compared with blood samples collected in the afternoon. The results highlight the importance of: (i) the timing of sample collection for appropriate interpretation of the bone marker data; and (ii) using the appropriate number of samples based on the variance obtained herein.

Changes in mandibular position and upper airway dimension by wearing cervical headgear during sleep

We previously reported that the wearing of cervical headgear induced forward displacement of the mandible in awake subjects. However, it was unclear whether such mandibular displacement also occurred during sleep. The purpose of this study was to examine changes in mandibular position and oropharyngeal structures that were induced by the wearing of cervical headgear during sleep. Ten healthy adults (7 male and 3 female) who gave their informed consent were included in this study. A pair of lateral cephalograms was taken with the patient in the supine position with and without cervical headgear at end-expiration during stage 1 to 2 non-rapid-eye-movement sleep. The Wilcoxon signed-rank test was used for a statistical analysis. The amount of jaw opening was significantly decreased by the wearing of the cervical headgear (P <.05), although no significant anteroposterior mandibular displacement was induced. The sagittal dimension of the upper airway was significantly reduced (P <.05); however, no significant changes were observed in the vertical length of the upper airway. Although the hyoid bone and the third cervical vertebra moved significantly forward by the wearing of the cervical headgear (P <.05), the relationship among the mandibular symphysis, the hyoid bone, and the third cervical vertebra did not change. These results suggest that cervical headgear significantly reduced the sagittal dimension of the upper airway during sleep, although there was no significant anteroposterior displacement of the mandible.